title: Taenia crassiceps upper limb fasciitis in a patient with untreated acquired immunodeficiency syndrome and chronic hepatitis C infection--the role of surgical debridement.
abstract: We report a rare case of human Taenia crassiceps infection in a 47-year-old female patient with untreated acquired immunodeficiency syndrome and chronic hepatitis C infection. Little experience exists regarding the appropriate treatment of this infection. Usually, a combination of anthelmintic drugs is applied. Whether surgical measures are indicated have not been clarified. In our patient, initial surgery showed an abscess and fluid collection with numerous transparent cysts localised in the subcutaneous tissue of the cubital fossa. Parasitological and pathological examinations identified these structures as larvae of the cestode T. crassiceps. After treatment with anthelmintic medications, the patient was discharged in good condition. However, the patient presented with the clinical symptoms of an acute fasciitis of the right upper extremity 7 days later. The deteriorating general condition entailing a pre-septical state demanded emergency debridement and fasciectomy of the right arm. After the surgery, the patient recovered fully.
  
  
  CONCLUSIONS
  Surgical treatment appears to be an important measure to reduce the tissue parasite load in patients with severe immunodeficiency. It also has to be questioned whether the bioavailability and the penetration of the drugs commonly administered is sufficiently high to treat such a fulminant infection alone.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland.
authors.forename: Nina
authors.initials: N
authors.lastname: Goesseringer
authors.forename: Nicole
authors.initials: N
authors.lastname: Lindenblatt
authors.forename: Daniela
authors.initials: D
authors.lastname: Mihic-Probst
authors.forename: Felix
authors.initials: F
authors.lastname: Grimm
authors.forename: Pietro
authors.initials: P
authors.lastname: Giovanoli
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D003646:Debridement / Q000379:methods; D005208:Fasciitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013621:Taenia / Q000145:classification; D013622:Taeniasis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D034941:Upper Extremity
chemical_list: D000871:Anthelmintics